Personal Responsibility, Privatization and the NHS

We can’t keep expecting any public service to absorb any and all demands made of it. We can’t keep expecting the public purse to keep pouring money into services at whim. That’s just not how a country works or grows. We can’t keep raising taxes to pay for run-away demand. We’ve been treating public service as if they’re in the same world as they were created in. They aren’t.

To my mind there are three things at play here:

Firstly, many of the NHS staff are outstanding. I have yet to run into clinical staff that are bad. Even the junior doctor who managed to prod my abscess like it was a lift button wasn’t bad. You just can’t do that job effectively year after year if you don’t care about what you’re doing. Nurses in particular do an amazing job on the whole. There are bad apples in the medical profession just like there are in any profession but being a public service it’s harder to get rid of bad staff when you’re already short staffed. Some effort being better than no effort.

Secondly, the NHS infrastructure is, for the most part, outdated. Sure, many hospitals build extensions, patch problem areas, build shiny facades but actually underneath its old and failing. Rectifying this will cost a great deal of money. I’ve had to spend some time with a relative recently in a hospital which has a nice shiny new centre but where the main building needs attention. Most hospitals and care centres need to be relocated and rebuilt. They’re now in the wrong place and can’t grow. There isn’t the money for that in the public purse.

Thirdly, there is not accounting in any of the published reports for personal responsibility. It seems that we are suggesting that no matter how we behave, what risks we choose to take – the NHS should “just be there” like mommy and daddy to make it all better. It’s time to ask why we think that’s ok.

To the question of why I support privatisation:

We need to be able to manage, rate and reward staff better. Bottom line, shit performing staff should be canned. Excellence should be rewarded. Mediocrity nurtured to grow. This is hard to do in the NHS because of various issues. By the way, this goes for all jobs, just turning up doesn’t count. Business knows how to find, train, invest in and exit staff.

We need to rebuild our health service infrastructure. Hospitals built in the 1970’s are in the wrong place now and/or too old. There’s no parking or the charges are likely to induce cardiac issues. We need new centres of care to replace these old places which can be sold on to bring billions in to the pot.

We need to modernise the tools and treatments we use. In some areas we’re leading the world. In others we’re a notch above using leeches and calling the shaman. Ok, I exaggerate – I’ve never actually seen a shaman being called.

We need to fund research in a more transparent way – it’s bloody Ponzi scheme in disguise at the moment. With all the millions raised by donations to various charities why do all these new drugs cost us so much? If you’re interested go learn how all this money ends up in the same group of companies we end up paying for the drugs.

The NHS isn’t a fluffy thing. It’s a vast organisation and we need better management of its resources by people who do management well. The NHS don’t do management well. There’s a conflict of interest. Management is a skill just like anything else. Get in organisations who know how to do this. This isn’t a place you want to “promote out of harm’s way”.

We need to be able to hold that management to account better and reward/penalise without affecting services. Penalising a trust effects the pot available to care. Penalising a company makes for an interesting shareholder meeting.

We need the slogan “Your health, your choices” mean more than where you get treated. It should mean we accept the responsibility for our health and should pay toward treatment when it’s the result of poor personal choices. Getting pissed and ending up in A&E shouldn’t cost the rest of the country. Smoking and getting cancer treatment shouldn’t cost the rest of the country. Causing an accident and needing treatment shouldn’t cost the rest of the country. Palliative care should be means tested for contributions against your estate.

If you’re not a UK citizen you should be paying for your care. When we leave the EU you definitely should be paying for your care or your insurance should be. We are not a freebie. If you’re a UK citizen abroad you should be paying for your care – that’s what travel insurance is for.

Being retired shouldn’t mean a delegation of the responsibility for your healthcare costs to the rest of the country. Yes you paid in and yes you also got lots for it during your working life. If you have the means you should pay something towards the cost of your treatment and care. If you don’t we’ll take care of you. You shouldn’t be able to hide your assets by transferring them to your children so it looks like you haven’t the means either. Your direct family should be taken into account at a different rate.

Medical insurance is a cost. We value what costs us money. You drive carefully partly because you know the impact on your bottom line if you drive like a dick and cause an accident. The same should apply to your health. If you’re unemployed or within the non-taxable bracket your healthcare should be free.

When everyone takes more responsibility for their choices there’s more money in the pot to help those who don’t have the means. When everyone sees a tangible cost each month for their lifestyle choices they get to make those choices better informed of the consequences. We don’t have to pay for everyone’s choices. Just ours and those who didn’t have any other choice. By the way, I’m still at a loss as to how anyone in the history of the world ever thought inhaling smoke wasn’t going to cause problems.

When we use private investment to upgrade and manage infrastructure and services we have better accountability and more leverage. If you want better health care then you’re going to have to take some responsibility for it and not just assume government will take care of you. It’s not actually your parents.

As always none of this exists in isolation to everything else that we have to take care of and consider.